CN103371858B - Endoscopic surgery equipment - Google Patents

Abstract

The invention discloses a kind of endoscopic surgery equipment.The surgery systems of the present invention have including multiple securing members, anvil block and the clamp assemblies for promoting the drive beam of actuated slider.Drive screw drives described drive beam motion.Elongate body is configured to be connected with described clamp assemblies.Flexible drive shaft is connected on described drive screw kinematic link, described kinematic link off-axis arrangement.Described clamp assemblies and elongate body are separable each other.

Description

Endoscopic surgery equipment

Cross-Reference to Related Applications

The application is to be filed on October 25th, 2011, Serial No. 13/280, a portion of 859 U.S. Patent application Divide and continue application case, be to be filed on October 25th, 2011 again, Serial No. 13/280, a part of 898 application continues Application case.Each of these applications application, entire contents are incorporated herein by reference.

Technical field

It relates to for carrying out surgical apparatuses, device and/or the system of endoscopic surgery and making of they Use method.More specifically, it relates to electromechanics, hand held surgical unit and/or system, its be configured to can The jettisonable load units of dismounting and/or the load units being intended for single use are used together, for clamping, cutting and/or coincide Tissue.

Background technology

The manufacturer of some operation devices has been developed over having and is applied to operation and/or manipulates the special of electro-mechanical surgical device Product line with drive system.In many instances, described electro-mechanical surgical device includes reusable Handleset, and The load units that jettisonable uses or is intended for single use.Before use, described in described load units can be used to selectively connect to On Handleset, then, after a procedure, then with described Handleset disconnect, so as to be disposed or in some instances by Sterilization is to reuse.

Having many in these electro-mechanical surgical device is all relatively costly for manufacturing, buy and/or operating.Exploitation For manufacture, buy and/or operation for be relatively inexpensive electro-mechanical surgical device, be manufacturer and terminal use remains the same from beginning to end Hope.Accordingly, there exist the demand of the electro-mechanical surgical device of mechanical linkage group, device and/or system after there is improvement.

Content of the invention

Referring to the drawings, more details and the scheme of exemplary embodiment of the present below will be described in greater detail.

In a scheme of the disclosure, surgery systems include clamp assemblies and have chlamydate Handleset, described pincers Clip assembly includes：Dismountable nail bin groupware, described nail bin groupware includes multiple securing members and to be limited at longitudinal direction therein narrow Groove；Anvil block, has securing member profiled surface thereon, and described nail bin groupware and anvil block are mounted in open position and close fit pair Move relative to each other between the make position of grip tissue together；Actuated slider, it is supported in described nail bin groupware, described Actuated slider is movably for promoting multiple securing members away from described nail bin；Drive beam, it includes vertical support and is propped up Cam member on described vertical support for the support, described cam member is positioned to translate with respect to described anvil block, in transmitting During securing member, described anvil block is maintained at closed position, and described vertical support is positioned to and described actuated slider neighbour Connect；And drive screw, it is supported in described detachable nail bin groupware, and described drive screw has threaded portion, wherein, Described drive beam can be threadedly coupled on the described threaded portion of described drive screw so that the rotation meeting of described drive screw Drive described drive beam lengthwise movement.Described surgery systems also include being configured to be connected described handle casing with clamp assemblies The elongate body got up, described elongate body includes described drive screw is mechanically coupled on the actuator shaft of described Handleset Flexible drive shaft, wherein, the rotary motion of actuator shaft can be delivered on described drive screw for described power transmission shaft, described elongated Main body includes flexible portion, and wherein, described flexible drive shaft is contained in described flexible portion.

In certain embodiments, the flexible portion of described surgery systems includes multiple interlocked segments.Kinematic link can be by institute State flexible drive shaft to couple together with drive screw.Described drive screw defines first longitudinal direction axis and described flexible drive shaft Define second longitudinal direction axis, and described kinematic link is with respect to described first and second longitudinal axis offset arrangement.

In certain embodiments, described kinematic link includes the nearside bonding part with described flexible drive shaft mechanical attachment And the distally bonding part with described drive screw mechanical attachment.Described nearside bonding part can include pod, its structure and Size can be mechanically engaged with the ball-and-socket joint being arranged in described flexible drive shaft far-end.Described distally bonding part can include Pin, its structure and size can be mechanically engaged with the U-clamp being arranged in described drive screw proximal end.

In certain embodiments, described surgery systems include operation support member, its be releasably fixed on described anvil block or In at least one of tissue contacting surface in staple cartridge, wherein, described operation passes through at least one anchor with support member Determine part to be fixed at least one of which in described anvil assembly and nail bin groupware, and wherein, described anvil assembly and nail bin group In part, at least one of which defines the lateral slit of the end for receiving at least one anchor log described, and release group Part, it is disposed at least one of which in described anvil assembly or nail bin groupware.

Described drive screw can be configured to activate described release assembly, thus discharging described anchor log and from described anvil Described operation support member is removed at least one of which in holder assembly and nail bin groupware.Described release assembly can wrap further Include and extended through the first bar of described longitudinal slit before activating described transmission component, and be operably connected to described the On one bar and the second bar that can be activated by described first bar, the end of described second bar before activating described transmission component at least Part puts in described lateral slit.

In another scheme of the disclosure, surgery systems include having chlamydate Handleset and with elongate body far-end Adjacent clamp assemblies, described clamp assemblies include：Nail bin groupware, described nail bin groupware includes multiple securing members and is limited at Longitudinal slit therein；Anvil block, has securing member profiled surface thereon, and described nail bin groupware and anvil block are mounted in open position With close fit alignment moves relative to each other between the make position of grip tissue；Actuated slider, it is supported on described nail In the assembly of storehouse, described actuated slider is movably for promoting multiple securing members away from described nail bin；Drive beam, it includes erecting Straight strut and the cam member being supported on vertical support, described cam member is positioned to translate with respect to described anvil block, with During transmitting securing member, described anvil block is maintained at closed position, and described vertical support is positioned to and described actuating Slide block adjoins；And drive screw, which defines first longitudinal direction axis and be supported in described nail bin groupware, described transmission spiral shell Bar has threaded portion, wherein, described drive beam can be threadedly coupled on the described threaded portion of described drive screw so that The rotation of described drive screw can drive described drive beam lengthwise movement.Described apparatus also has and is configured to described handle group The elongate body that part and clamp assemblies couple together, described elongate body includes being mechanically coupled to described drive screw described Flexible drive shaft on the actuator shaft of Handleset, wherein, the rotary motion of actuator shaft can be delivered to described by described power transmission shaft On drive screw.Described flexible drive shaft and drive screw can be coupled together by kinematic link, and described kinematic link is relatively In described first and second longitudinal axis offset arrangement.

The elongate body of described surgery systems can include accommodating the flexible portion of flexible drive shaft.Described flexible portion can To include multiple interlocked segments.Described kinematic link can include nearside bonding part with described flexible drive shaft mechanical attachment and Distally bonding part with described drive screw mechanical attachment.Described nearside bonding part includes pod, and its structure and size can Mechanically engage with the ball-and-socket joint being arranged in described flexible drive shaft far-end.Described distally bonding part includes pin, its knot Structure and size can be mechanically engaged with the U-clamp being arranged in described drive screw proximal end.

In certain embodiments, described anvil block or at least one of tissue contacting surface of staple cartridge can be released Fix operation support member with putting, wherein, described operation support member is fixed to by described anvil block by least one anchor log In at least one of which in assembly and nail bin groupware, and wherein, at least one of which limit in described anvil assembly and nail bin groupware Determine the lateral slit of the end for receiving at least one anchor log wherein said.Release assembly is disposed in described anvil block group Inside at least one of which in part or nail bin groupware.

Described drive screw can be configured to activate described release assembly, thus discharging described anchor log and from described anvil Described operation support member is removed at least one of which in holder assembly and nail bin groupware.Described release assembly further includes at Extend through the first bar of described longitudinal slit before activating described transmission component, and be operably connected to described first bar The second bar that is upper and being activated by described first bar, the end of described second bar is at least part of before activating described transmission component Put in described lateral slit.

The Handleset of described surgery systems, clamp assemblies and Slender axles assembly can be separated from one another.

In certain embodiments, described system includes：Power supply, it is configured to provide electric energy；Control assembly, it is joined Put for accepting at least one user input；First motor, its be coupled on described power supply and described in being configured to respond to extremely Lack a user input and run；Second motor, its be coupled on described power supply and be configured to respond to described at least one User input and run；And selection transmission case assembly, it includes at least one tooth with described flexible drive shaft mechanical attachment Wheel element, wherein, described first motor is configured to selectively moved at least one teeth parts described and described second motor It is meshed, thus activating described flexible drive shaft.

In another scheme of the disclosure, surgery systems include Handleset, described Handleset include shell and with The clamp assemblies that elongate body far-end adjoins, described clamp assemblies include：Nail bin groupware, described nail bin groupware includes multiple fastenings Part and be limited at longitudinal slit therein；Anvil block, has securing member profiled surface thereon, and described nail bin groupware and anvil block are installed Become and move relative to each other between open position and close fit align with the make position of grip tissue；Actuated slider, is propped up In described nail bin groupware, described actuated slider is movably for promoting multiple securing members away from described nail bin for support；Transmission Beam, including vertical support and the cam member being supported on vertical support, disposes described cam member with respect to described anvil block Translation, for transmitting securing member during described anvil block is maintained at closed position, and dispose described vertical support with Described actuated slider adjoins；And drive screw, define first longitudinal direction axis and be supported in described nail bin groupware, described Drive screw has threaded portion, and wherein, described drive beam can be threadedly coupled to the described threaded portion of described drive screw Above so that the rotation of described drive screw can drive described drive beam lengthwise movement.Described system has and is configured described handss The elongate body that handle assembly and clamp assemblies couple together, described elongate body includes to be mechanically coupled to described drive screw Flexible drive shaft on the actuator shaft of described Handleset, wherein, the rotary motion of actuator shaft can be delivered to by described power transmission shaft On described drive screw, and the kinematic link that described flexible drive shaft and drive screw can be coupled together, deviate described First and second longitudinal axis are arranging described kinematic link.Described Handleset, clamp assemblies and Slender axles assembly are divided each other From.Described system includes：Power supply, is configured to provide electric energy；Control assembly, is configured to accept at least one user defeated Enter；First motor, is coupled on described power supply and is configured to run to respond at least one user input described；Second electricity Machine, is coupled on described power supply and is configured to run to respond at least one user input described；And select change speed gear box group Part, including at least one teeth parts with described flexible drive shaft mechanical attachment, wherein, described first motor is configured to select Property ground at least one teeth parts mobile described be meshed with described second motor, thus activating described flexible drive shaft.

In another scheme, surgery systems include clamp assemblies, and described clamp assemblies include：Nail bin groupware, described in it Nail bin groupware includes multiple securing members and is limited at longitudinal slit therein；Anvil block, has securing member profiled surface, institute thereon State nail bin groupware and anvil block is mounted between open position and close fit align with the make position of grip tissue with respect to that This motion；Actuated slider, it is supported in described nail bin groupware, and described actuated slider is movably multiple tight for promoting Firmware is away from described nail bin；Drive beam, it includes cam member, and described cam member is positioned to translate with respect to described anvil block, It is used for, during transmitting securing member, described anvil block is maintained at closed position；And drive screw, which defines first Longitudinal axis and being supported in described nail bin groupware, described drive screw has threaded portion, and wherein, described drive beam is permissible It is threadedly coupled on the described threaded portion of described drive screw so that the rotation of described drive screw can drive described drive beam Lengthwise movement.Described apparatus includes being configured to the elongate body being connected with described clamp assemblies, and described elongate body includes Flexible drive shaft, described power transmission shaft can transmit rotary movement on described drive screw, and can be by described flexible driving The kinematic link that axle and drive screw couple together, wherein, described kinematic link is with respect to described first and second longitudinal axis Offset arrangement.Described clamp assemblies and Slender axles assembly are each other can be detached, and described elongate body is configured to and actuator It is connected.

Described surgery systems, in certain embodiments, including the actuator being disposed in Handleset.Can include by It is configured to provide for the power supply of electric energy.Described system can include the control group being configured to accept at least one user input Part.

In certain embodiments, described system have be coupled on described power supply and be configured to respond to described at least one Individual user input and the first motor of running.Second motor can be coupled on described power supply and described in being configured to respond to extremely Lack a user input and run.Described system can have selection transmission case assembly, and it includes and described flexible drive shaft machine Tool connection at least one teeth parts, described first motor be configured to selectively moved at least one teeth parts described with Described second motor is meshed, thus activating described flexible drive shaft.

In certain embodiments, described drive beam is included for supporting described cam member and promoting vertically propping up of slide block Post.Described system can have the shell including motor.Can include being configured to accept the control assembly of user input.

Brief description

Referring to the drawings, the different embodiments of the disclosure are described in this, wherein：

Fig. 1 is the axonometric chart of the Electromechanical surgical system according to the disclosure；

Fig. 2 is according to the operating theater instruments of the Electromechanical surgical system in Fig. 1 of the disclosure, slender member and end effector Exploded perspective view；

Fig. 3 is the sectional view of the operating theater instruments of the Fig. 1 according to the disclosure along the 3-3 intercepting of Fig. 1；

Fig. 4 is the vertical view cutaway drawing of the operating theater instruments of the Fig. 1 according to the disclosure along the 4-4 intercepting of Fig. 1；

Fig. 5 is the front perspective view according to the operating theater instruments in Fig. 1 of the disclosure, the slender member in wherein Fig. 2 be with Described operating theater instruments are detached；

Fig. 6 is the front perspective view according to the end effector in Fig. 1 of the disclosure；

Fig. 7 is the sectional view according to the end effector in Fig. 1 of the disclosure；

Fig. 8 is the sectional view of the amplification according to the end effector in Fig. 1 of the disclosure；

Fig. 9 is the rear perspective view of the amplification according to the end effector in Fig. 1 of the disclosure；

Figure 10 is the exploded perspective view according to the end effector in Fig. 1 of the disclosure；

Figure 11 is the sectional view according to the end effector in Fig. 1 of the disclosure；

Figure 12 is the partial exploded side view of the coupling member according to the end effector in Fig. 1 of the disclosure；

Figure 13 is the exploded partial perspective view of the coupling member according to the end effector in Fig. 1 of the disclosure；

Figure 14 is the sectional view of the coupling member according to the end effector in Fig. 1 of the disclosure；

Figure 15 is the front perspective view of the end effector according to the disclosure, and in figure part is detached, and described end is held Row device includes the operation nail bin supporting member being fixed in its tissue contacting surface；

Figure 16 is the amplification stereogram of the anvil assembly far-end of end effector, presents according to the disclosure operationally It is fixed to the operation nail bin supporting member in its tissue contacting surface；

Figure 17 is the amplification stereogram of the nail bin groupware of end effector, present according to the disclosure be fixed to its tissue Operation nail bin supporting member in contact surface；

Figure 18 is the top perspective view of the anvil assembly far-end of the end effector according to the disclosure, described end effector Including the stitching thread release assembly being shown as opening under form；

Figure 19 is the top perspective view of the anvil assembly in Figure 18, presents and is released by detached stitching thread according to the disclosure Put the part of assembly；

Figure 20 is the face upwarding stereogram according to the anvil assembly in Figure 18 of the disclosure；

Figure 21 is the plan view from above of the anvil assembly in Figure 18, presents the seam under arrangement for closed configuration according to the disclosure Zygonema discharges assembly；

Figure 22 is the plan view from above of the anvil assembly in Figure 18, and wherein keeper is removed from described anvil assembly；

Figure 23 is the plan view from above of the anvil assembly in Figure 18, presents and is opening the seam under form according to the disclosure Zygonema discharges assembly；

Figure 24 is the plan view from above according to the anvil assembly in Figure 18 of the disclosure, and wherein keeper is from described anvil block group Remove on part；

Figure 25 is the top perspective view of the nail bin groupware far-end of the end effector according to the disclosure, described end effector Discharge assembly including stitching thread；

Figure 26 is the top perspective view of the nail bin groupware in Figure 25, presents and is released by detached stitching thread according to the disclosure Put the part of assembly；

Figure 27 is the face upwarding stereogram according to the nail bin groupware far-end in Figure 25 of the disclosure；

Figure 28 is the plan view from above of the nail bin groupware in Figure 25, presents the seam under arrangement for closed configuration according to the disclosure Zygonema discharges assembly；

Figure 29 is the plan view from above of the nail bin groupware in Figure 25, presents and is opening the seam under form according to the disclosure Zygonema discharges assembly；

Figure 30 is the axonometric chart of the end effector far-end according to another embodiment of the disclosure, described end effector Discharge assembly including stitching thread；

Figure 31 is the enlarged drawing according to thin portion indicating area in Figure 30 of the disclosure；

Figure 32 is the top perspective view unloading the anvil assembly far-end except anvil covers, presents and is activating according to the disclosure Stitching thread release assembly under form；

Figure 33 is the top perspective view of the anvil assembly far-end in Figure 32, presents according to the disclosure by detached suture Line discharges the part of assembly；

Figure 34 is the plan view from above of the anvil assembly in Figure 32, presents and is not activating under form according to the disclosure Stitching thread discharges assembly；

Figure 35 is the plan view from above of the anvil assembly in Figure 32, presents and is activating the seam under form according to the disclosure Zygonema discharges assembly；

Figure 36 is the face upwarding stereogram of the nail bin groupware far-end of the end effector in Figure 30, presents according to the disclosure Assembly is discharged by detached stitching thread；

Figure 37 is the top perspective view discharging assembly according to the stitching thread in Figure 36 of the disclosure；

Figure 38 is the face upwarding stereogram discharging assembly according to the stitching thread in Figure 36 of the disclosure, and in figure part is to separate 's；

Figure 39 is the plan view from above of the stitching thread release assembly in Figure 36, presents and is not activating shape according to the disclosure Stitching thread release assembly under state；And

Figure 40 is the plan view from above of the stitching thread release assembly in Figure 36, presents and is activating form according to the disclosure Under stitching thread release assembly.

Specific embodiment

The embodiment of Electromechanical surgical system, equipment and/or the device of the disclosure is described in detail with reference to the accompanying drawings, wherein In every width accompanying drawing of several views of the drawings, same reference numerals refer to identical or corresponding element.As used herein, term " distally " refers to the part farther out away from user of described Electromechanical surgical system, equipment and/or device or its part, and term is " near Side " refers to the part nearer away from user of described Electromechanical surgical system, equipment and/or device or its part.Term " left side " and " right side " refers respectively to, when described surgery systems, equipment and/or device orient are under non-rotating form, proximally, from towards From the point of view of the user perspective of described Electromechanical surgical system, equipment and/or device far-end, described Electromechanical surgical system, equipment and/or dress Put or its part is in left side（As larboard）With on right side（As starboard）Part.

With reference first to Fig. 1-5, according to the disclosure an embodiment it is shown that a kind of dynamo-electric, hand-held, electric operation System and generally referring to as 10.Electromechanical surgical system 10 includes a kind of surgical apparatuses or device, with dynamo-electric, hand-held, electronic The form of operating theater instruments 100, it is arranged to via shaft assembly 200 optionally by multiple different end effectors 400 Attach to this.End effector 400 and shaft assembly 200 are configured to pass electromechanics, hand-held, electrical surgical instrument or handle group Part 100 is being activated and to be manipulated.Especially, operating theater instruments 100, shaft assembly 200 and end effector 400 are all each other may be used Detached, to configure operating theater instruments 100 to be selectively connected shaft assembly 200, next, shaft assembly 200 is configured to select Property ground connect multiple different end effectors 400 in any one end effector.

In order to describe exemplary electromechanical, hand-held, electrical surgical instrument 100 in detail structurally and operationally, Ke Yiyin With being filed in the international application of September in 2008 22 days, Application No. PCI/US2008/077249（International publication number is WO2009/ 039506）With the U.S. Patent application of the Serial No. 12/622,827 being filed on November 20th, 2009, it is complete that each is applied for Portion's content is incorporated herein by reference.

As Figure 1-4, generally, operating theater instruments or Handleset 100 include handle casing 102, and handle casing 102 includes Lower housing section 104, middle housing part 106 and upper case portion 108, wherein, middle housing part 106 is from lower housing section 104 extend out and/or are supported on lower housing section 104, and upper case portion 108 is to extend from middle housing part 106 Come and/or be supported on middle housing part 106.Middle housing part 106 and upper case portion 108 are separated into distal half 110a and proximal half 110b, wherein, distal half 110a is to extend out and monolithic molding therewith from lower housing section 104, Proximal half 110b passes through using multiple securing members（Fig. 3 and Fig. 4）Can be connected with distal half 110a.After connection, distally half Portion 110a and proximal half 110b collectively defines handle casing 102, has cavity 102a, control assembly 150 in handle casing 102 It is disposed in cavity 102a with drive mechanism 160.Apparatus 100 also includes being coupled to control assembly 150 and drive mechanism 160 Power supply（Do not show）.As described in discuss in further detail below, control assembly 150 can include one or more logic controls Device and/or user interface（For example, switch, button, trigger, touch screen etc.）, and it is configured to control apparatus 100, particularly, The various operations of drive mechanism 160.Described Handleset is configurable to allow described device system user to hold, or can join Be set to can connect on shaft assembly or elongate body discussed below on control station.

The lower housing section 104 of apparatus 100 defines the aperture being formed thereon surface（Do not show）, it is located at middle housing The under or within of part 106.The aperture of lower housing section 104 provides passage, is available for wire and other various electric leads are worn Cross to interconnect with the electric component in lower housing section 104（For example, power supply and any corresponding Power Control electricity Road）And interconnect with the electric component in middle housing part 106 and/or upper case portion 108（For example, control assembly 150th, drive mechanism 160 etc.）.

With reference to Fig. 3 and Fig. 4, the distal half 110a of upper case portion 108 defines nasal portion or coupling part 108a.Nose Cone 114 is supported in nasal portion 108a of upper case portion 108.The upper case portion 108 of handle casing 102 provides arrangement There is the housing of drive mechanism 160.In order to realize the various operations of apparatus 100, configuration drive mechanism 160 comes drive shaft and/or tooth Wheel component.Especially, drive mechanism 160 is configured to drive shaft and/or geared parts, to select with respect to handle casing 102 Selecting property around longitudinal axis A-A（Fig. 6 A and Fig. 6 B）Rotary end effector 400, relative to each other to move end effector 400 jaw members and/or transmitting securing member, so that the tissue held in cut-out end effector 400.

As Fig. 3 and Fig. 4, drive mechanism 160 includes being close to the selection transmission case assembly 162 of nearside with respect to shaft assembly 200. It is the function selecting module 163 with the first motor 164 close to select transmission case assembly 162, the function of the first motor 164 is The selectively moved teeth parts selecting in transmission case assembly 162 come and the input drive disk assembly 165 with the second motor 166 It is meshed.Referring specifically to Fig. 5, the distal half 110a of upper case portion 108 defines coupling part 108a, coupling part 108a It is arranged to accept the corresponding driving coupling assembly 210 of shaft assembly 200.

With continued reference to Fig. 5, the coupling part 108a of apparatus 100 includes the driving coupling assembly for receiving shaft assembly 200 210 cylindrical recess 108b.Coupling part 108a can accommodate three rotatable drive coupling 118,120,122.When When shaft assembly 200 and apparatus 100 supporting connection, each of three rotatable drive coupling drive coupling, i.e. device Each of first drive coupling 118 of tool 100, the second drive coupling 120 and the 3rd drive coupling 122 are driven Adapter, rotary connector sleeve pipe that can be mechanically corresponding engages, and corresponding connector ferrule is：Shaft assembly 200 the first connector ferrule 218, the second connector ferrule 220 and the 3rd connector ferrule 222.

The drive coupling 118,120,222 of apparatus 100 is joined with the connector ferrule 218,220,222 of shaft assembly 200 Set connects permission and independently transmits revolving force via the respective AUI in three corresponding AUIs.Apparatus It is independently rotated that 100 drive coupling 118,120,122 is configured to pass drive mechanism 160.At this point, drive mechanism 160 Function selecting module 163 can select one or more of the drive coupling 118,120,122 of apparatus 100 drive coupling To be driven by the input drive disk assembly 165 of drive mechanism 160.

With continued reference to Fig. 3 and Fig. 4, drive mechanism 160 includes selecting transmission case assembly 162 and function selecting module 163, its Middle function selecting module 163 is located near the position selecting transmission case assembly 162, and its function is selectively moved selection speed change Teeth parts in box assembly 162 to be meshed with the second motor 166.So, drive mechanism 160 just can select in preset time Drive to selecting property one or more drive coupling 118,120,122 of apparatus 100.

Since each of the drive coupling of apparatus 100 118,120,122 adapter is all by key and/or basic Upper irrotational interface is connected with the corresponding connector ferrule 218,220,222 of shaft assembly 200, so working as shaft assembly 200 When being coupled on apparatus 100, optionally revolving force can be passed to shaft assembly 200 from the drive mechanism 160 of apparatus 100.

The selective rotation of drive coupling 118,120 and/or 122 of apparatus 100 allows apparatus 100 optionally to activate The difference in functionality of end effector 400.In certain embodiments, it is possible to use any number of drive coupling 118,120 and/ Or 122 running end effector 400.Described as discussed in more detail below, the first drive coupling 118 of apparatus 100 Selective and independent rotation is corresponding to selective and independent the opening and closing of the jaw members of end effector 400 Operation, and the actuated slider 440 corresponding to end effector 400（Fig. 8）Transmission operation.3rd transmission of apparatus 100 is even The selective and independent rotation connecing device 120,122 is corresponding to the camera assembly 500 rotating with respect to end effector 400 Selective and independent around pivoting.Drive coupling 120 can be used to respect to shaft assembly 200 around pivoting end Executor 400 and/or rotary end effector 400.

Fig. 6 shows elongate body or shaft assembly 200 and end effector 400.Elongate body or shaft assembly 200 include The flexible portion 202 that rigid element 204 is coupled together with end effector 400.As shown in Figure 7 and Figure 8, rigid element 204 Contain the first connector ferrule 218, the first connector ferrule 218 is coupled to the flexible biography extending through flexible portion 202 On moving axis 119.Axle 119 can be by any suitable flexibility and the torsion that can carry out Articulating together with flexible portion 202 Rigid material is made, to allow end effector 400 to transport with articulated type in non-Articulating position with respect to rigid element 204 Carry out Articulating between dynamic position, wherein, in described non-Articulating position, limited by end effector 400 First longitudinal direction axis is substantially alignd with the second longitudinal direction axis being limited by rigid element 204, and in described Articulating Position, is substantially arranged to respect to the second longitudinal direction axis of rigid element 204 by the first longitudinal direction axis of end effector 400 It is non-zero angle.Axle 119 can be made up of rustless steel or similar material.

As shown in figure 8, flexible portion 202 includes multiple interlocked segments 206, each interlocked segments defines opening therethrough 206a.As shown in figure 8, axle 119 is arranged in opening 206a.Each section in interlocked segments 206 all includes pod in its near-end 206b, includes ball-and-socket joint 206c in its far-end.The ball-and-socket joint 206c of one interlocked segments 206, its structure and size can be with The pod 206b of the neighbouring interlocked segments 206 in distally engages, thus allowing whole flexible portion 202 to bend, such that it is able to around rigidity The longitudinal axis of part 204 carry out Articulating towards any desired direction in whole 360 ° of spaces.

The Articulating of flexible portion 202 can be realized by drag-line 205.In certain embodiments, it is possible to use It is coupled on end effector 400 and pass through four radially equidistant spaced apart cables of flexible portion 202.Especially, such as Shown in Fig. 9, can arrange every cable 205 in the respective opening 206d of interlocked segments 206.Therefore, it is applied to one or more Pulling force on cable carries out the direction of Articulating by adjusting flexible portion 202.Entitled " have jointly owned In the link carrying out Articulating of intermediate link control system ", Application No. 61/510091 U.S. Provisional Patent Application, Disclose a kind of cable Articulating apparatus, entire contents are incorporated herein by reference.

Figure 10-14 illustrates part and the operation of end effector 400.End effector 400 has including nail bin groupware 432 and the clamp assemblies of anvil block 434.Nail bin groupware 432 can accommodate one or more securing members 433 being disposed in its inside （Figure 10）, and nail bin groupware 432 is configured to when apparatus 100 is launched, just using securing member 433.Anvil block 434 can be movably （For example, around pivoting）It is installed on end effector 400 and can move between the open and the closed positions, its In, under open position, anvil block 434 is spaced apart from each other with nail bin groupware 432, under make position, anvil block 434 and nail bin groupware 432 close fit alignment, thus grip tissue.

With reference to Figure 10, show the exploded view of end effector 400.End effector 400 is also included with elongated passageway 411st, the carrier 431 of base 412 and two straight parallel walls 414,416, described straight parallel wall includes several mounting structures, As recess 439, for supporting nail bin groupware 432 and anvil block 434.Longitudinal slit 413 extends through elongated passageway 411.

Carrier 431 also includes being arranged plate lid 415 on its bottom surface.Plate lid 415 is configured to thin with carrier 431 Long-channel 411 is mutually frictionally engaged, and its function is the damage from the part along the outside movement of carrier 431 for the protective tissue.Carry Device 431 also includes being disposed in respective straight parallel wall 414,416 near-ends and being configured to the housing with end effector 400 A pair of key-shaped piece 407 and 409 of part 410 connection.

With continued reference to Figure 10, the distal part of elongated passageway 411 supports and includes multiple surgical fasteners 433 and multiple correspondence Emitter or propeller 437 nail bin groupware 432.As described in more detail below, end effector 400 include having upright The actuated slider 440 of camshaft wedge 444, upright camshaft wedge 444 is configured to apply securing member driving force in propeller 437 On, this can drive securing member 433 away from nail bin groupware 432.Shaped with the upper surface in elongated passageway wall 414 and 416 by meeting The lateral struts 436 that are mutually frictionally engaged of corresponding recess 439 nail bin groupware 432 is maintained in elongated passageway 411.These structures It is used for limiting horizontal, longitudinal direction in elongated passageway 411 for the nail bin groupware 432 and facade motion.

Multiple spaced apart longitudinal slits（Do not show）Extend through nail bin groupware 432 and accommodate the straight of actuated slider 440 Vertical camshaft wedge 444.Described slit is communicated with multiple caves 442, in cave 442, is supported by multiple securing members 433 and propulsion respectively Device 437.By configuring the propeller keeper below nail bin groupware 432（Do not show）To fix propeller 437, described propulsion Device keeper can be before propeller 437 passes through actuated slider 440 joint, and support and align propeller 437.In operating process In, it is translated across nail bin groupware 432 with actuated slider 440, the horn shape leading edge of camshaft wedge 444 can progressive contact propeller 437, lead to described propeller vertically to translate in slit 446, thus promoting securing member 434 from that.Retouching as discussed State, nail bin groupware 432 also includes longitudinal slit 485 to allow blade 474 mobile therethrough.

With continued reference to Figure 10, end effector 400 includes being disposed in the anvil covers 435 of anvil block 434 top.Anvil covers 435 meeting protective tissues are from the damage of the part along the outside movement of anvil block 434.Anvil covers 435 include the relative installation wing 450 He 452, its size and structure can be engaged with the location indentations 454 and 456 of anvil block 434 respectively.The function of the wing 450 and 452 is installed It is alignment anvil block 434 and nail bin groupware 432 in closing course.As described in more detail below, anvil block 434 and anvil covers 435 It is configured to be maintained at and open under form until closure.

Anvil block 434 is connected on carrier 431 around pivoting.Carrier 431 includes being formed at respective key-shaped piece 407 He A pair of openings 421 and 422 on 409.Anvil covers 435 also include forming in a pair of opposed open 457 and 459 therein.Pivot Pin 417, or a pair of pin, through opening 421,422,457 and 459, to allow anvil block 434 to be connected to carrier around pivoting On 431.

As shown in Figure 10, end effector 400 further includes axial drive screw 460, in anastomosis surgical procedure Middle actuated slider 440 will be passed to by the Rotational drive that flexible drive shaft 119 applies.Drive screw 460 is pivotably supported In carrier 431 and include threaded portion 460a and nearside bonding part 460b.Drive screw 460 is removably secured to follow closely The far-end of storehouse assembly 432 simultaneously includes one or more bearings 466 by frictional fit around the 460b of bonding part.This can permit Permitted drive screw 460 to rotate with respect to carrier 431.The distal shell component 410 of end effector 400 is via one or more Bolt 412 is connected on the near-end of carrier 431.Housing member 410 includes hole 414 therethrough, can accommodate wherein Bonding part 460b.

As shown in figures 10-14, power transmission shaft 119 includes the coupling member 500 in its far-end, and it is coupled to shaft assembly The kinematic link group 502 that 200 power transmission shaft 119 is coupled together with the drive screw 460 of end effector 400.Coupling member 500 Including distally ball-and-socket joint 500a and a pair relative proximal end face 500b being located at its cervical region.It is arranged in housing parts 410 Kinematic link group there is the kinematic link 502 with respect to drive screw 460 off-axis.Especially, limited by kinematic link 502 Fixed longitudinal axis become non-parallel angle with respect to by the longitudinal axis that drive screw 460 limits（For example, non-zero angle）. In certain embodiments, kinematic link 502 can be arranged along with drive screw 460 identical longitudinal axis.

Kinematic link 502 includes nearside bonding part 501 and distally bonding part 503.Nearside bonding part 501 is configured to Engage with the ball-and-socket joint 500a of coupling member 500, and the size of distally bonding part 503 and structure can be with drive screws 460 proximal joint sections 460b engages.Especially, bonding part 501 includes pod 501a, and its structure and size can be with balls And-socket joint 500a engages.Kinematic link 502 also includes limiting a pair of opposed surface 501b of opening 510c.Coupling member 500 Ball-and-socket joint 500a inject nearside bonding part 501 pod 501a in, thus allow respective surface 500b and 501b that This is adjacent and is mechanically fitted to each other.The mechanical attachment of ball-and-socket joint 500a and pod 501a can prevent kinematic link 502 from Depart from coupling member 500, and the adjacent of surface 500b and 501b allows for the rotary motion of coupling member 500 to be delivered to biography On dynamic connecting rod 502.

As figs 11-13, the distally bonding part 503 of kinematic link 502 includes pin 503a in its far-end, and pin 503a is horizontal To extending through wherein, and its structure and size can be engaged with the bonding part 460b of drive screw 460.Drive screw 460 The structure of bonding part 460b and size can be engaged with pin 503a as U-clamp.Especially, bonding part 460b is in its far-end Including the hole 461a for being inserted bonding part 503.As shown in figure 13, bonding part 460b also includes being limited at hole 461a both sides, thus a pair diametical opening 461b and 461c forming U-clamp 461d.As shown in figure 13, opening 461b and 461c can be formed at its far-end as the otch with entrance, thus allowing to be inserted pin 503a.

With reference to Figure 10 and Figure 11, end effector 400 further includes the drive beam 462 being disposed in carrier 431. Drive beam 462 includes vertical support 472 and the abutment surface 476 engaging with the central supporting wedge 445 of actuated slider 440.Pass Dynamic beam 462 also includes the cam member 480 being disposed on vertical support 472 top.The size of cam member 480 and structure can To be engaged with the evagination wheel face 482 with respect to anvil block 434 and to translate, thus progressively clamping anvil block during transmitting securing member 434 against bodily tissue.

Longitudinal slit 484 extends through anvil block 434, is available for vertical support 472 translation and uses.This allows cam member 480 Can move between anvil covers 435 and anvil block 434 during transmitting securing member.In certain embodiments, anvil covers 435 are gone back The corresponding longitudinal slit being formed can be included on its inner face（Do not show）And anvil covers 435 are fixed on the upper of anvil block 434 Surface, thus form the passage running through therebetween.

Drive beam 462 includes distally and keeps foot 488a and nearside to keep foot 488b, and distally keeps foot 488a and nearside to keep Foot 488b each has hole 489a and 489b of insertion.Hole 489a and 489b can be threaded or smooth, for wearing Cross drive screw 460 therein mobile.The travelling nut 490 with insertion screwed hole 490a is disposed in distally holding foot 488a With nearside keeps between foot 488b.Drive screw 460 is threadedly coupled on travelling nut 490 so that with biography by hole 490a Dynamic screw rod 460 rotates, and travelling nut 490 can move along the longitudinal direction along the longitudinal axis being limited by drive screw 460 and go back Engage with keeping foot 488a and 488b.

In use, turn clockwise with drive screw 460, travelling nut 490 and drive beam 462 can be towards distally sides To movement, push down on cam surface 482 with cam member 480 and close anvil block 434.Drive beam 462 is also towards distally side To promoting slide block 440, then, engage with propeller 437 via cam wedge 444, thus launching securing member 433.Drive beam 462 Can be made up of any suitable primary material, including but not limited to, plastics, metal and combinations thereof.Travelling nut 490 is permissible It is made up of any suitable secondary raw material, equally including but not limited to, plastics, metal and combinations thereof.Primary material and secondary Raw material can be identical or different.In certain embodiments, drive beam 462 can include the single holding with insertion screwed hole Foot, it can use and is threadedly coupled on drive screw 460.

With reference to Figure 10, drive beam 462 also includes the blade 474 of tissue fixed for cutting.In anastomosis operation, knife Piece 474 slightly lags behind actuated slider 440 and moves, thus the formation otch in the ranks in fixing bodily tissue.With drive beam 462 to Distal direction is driven, and the abutment surface 476 of vertical support 472 distal direction can promote slide block 440, thus ejecting securing member 433, and use blade 473 cutting to organize simultaneously.Blade 474 and drive beam 462 move through longitudinal slit 484 and 485.With biography Dynamic beam 463 distal direction is driven, and drive beam 463 can close anvil block, and also promotes slide block 440, and slide block 440 is moving Ejection securing member 433 before blade 474.It is ejected with securing member 433, they can nestle up has multiple anvil block caves（Do not show Show）Anvil block 434 tissue contacting surface（For example, downside）Deform.

Figure 15 shows another embodiment of end effector 400.Anvil block 434 defines a pair of nearside depression 434d, They are formed at the near proximal ends of anvil block 434 and are disposed on each side in longitudinal slit 484 opposite sides.Anvil block 434 also define a pair of distally depression 434e, and they are formed at the proximate distal ends of anvil block 434 and are disposed in longitudinal slit 484 On each side in opposite sides.In one embodiment, nearside depression is recessed to each pair in 434e to 434d and distally depression In cave, at least one of which depression can be non-circular and shrink, that is, have the width dimensions reducing, will pass through friction Engage and/or compression anchor log " S ".In addition, when anvil covers 435 and anvil block 434 assembling, anvil covers 435 define a pair of shape Become contrary depression 435a wherein, they are alignd to 434d with the nearside depression being formed in anvil block 434.

Anvil block 434 further includes that operation anvil block support member " B1 ", pledget or other any suitable operations are planted Enter thing, it is operationally fixed in lower surface or the tissue contacting surface of anvil block 434, thus covering by anchor log " S " The length at least some anvil block cave and/or at least a portion longitudinal slit 484.As used by the disclosure, term " anchor log " Can be understood as including but not limited to stitching thread, screw thread, tether, band, band, rope, wire, cable, securing member, stud or its The material of his any set purpose being suitable for disclosed in this.In certain embodiments, described anchor log is discussed below The extension of identical staple line reinforcement material.Described anchor log may be constructed a composition portion of described identical staple line reinforcement material Point, or can be made up of same or analogous material and be attached on described identical staple line reinforcement material.Especially, anchor log " S " tightens up around portions of proximal and nearside depression in operation anvil block support member " B1 " each depression to 434d, and anchor Determine part " S " also to tighten up around distal part and distally depression in operation anvil block support member " B1 " each depression to 434e.

When fixing operation is with, when on anvil block support member " B1 " to anvil block 434, operation anvil block support member " B1 " includes shaping The nearside recess pair 434d being alignd in its lateral edges and with the nearside depression of anvil block 434, is formed in its lateral edges and anvil block The distally recess pair that 434 distally depression aligns to 434e, and be formed in its proximal and align with longitudinal slit 484 Nearside recess.Operation anvil block support member " B1 " further includes tongue-like pieces or the key-shaped piece extending out from its distal side edge, Operation anvil block support member " B1 " is attached on anvil block 434 in assembling process with facilitating.It is contemplated that operation is being used After anvil block support member " B1 " is fixed on anvil block 434, and before packaging or shipment, by described tongue-like pieces from operation anvil Disassemble in seat support member " B1 ".

As shown in Figure 18-24, anvil block 434 further includes to be disposed between anvil block 434 and anvil covers 435, be in Anvil block release assembly 574 at the position that distally depression operationally aligns to 434e.Release assembly 574 includes defining and passes through The guide plate 575 of the logical arcuate groove 575a being formed.Described as discussed in more detail below, arcuate groove 575a structure and size can be used to Receive the instrument of insertion（Do not show）.

Reference picture 18-20, release assembly 574 also includes being pivotably connected to anvil block 434 and/or optional anvil Lock on flap 435 or anchor 576.Anchor 576 includes defining elongated passageway or the rod body part of slit 576b in inside Divide the 576a and cam follower 576c extending out from its edge.Cam follower 576c operationally with distally depression in 434e Individual depression alignment, that depression preferably with distally depression centering with relatively large width dimensions is alignd.

Stitching thread release assembly 574 further includes can pivotably be connected to anvil block 434 and/or optional anvil block Anchor actuation member 577 on lid 435.Actuation member 577 includes the eccentric cam 577a defining center of rotation axis, permits Permitted actuation member to rotate around described center of rotation axis.Actuation member 577 includes projection or boss 577b, described projection or boss 577b along the center of rotation axis being arranged essentially parallel to eccentric cam 577a and offset radial distance direction, from bias Cam 577a surface extends out.Boss 577b is slidably and rotatably arranged in elongated slot 576b of anchor 576 In.Actuation member 577 further includes release lever 577c, and release lever 577c is from side substantially opposite with boss 577b, convex from bias Extend out along the direction of substantially tangentially on wheel 577a.Release lever 577c defines the pin 577d being formed thereon, and sells 577d Align with the arcuate groove 575a of guide plate 575.In operation, rotate with eccentric cam 577a, the pin 577d meeting of release lever 577c Follow described rotation and move along the path of the arcuate groove 575a of guide plate 575.

As Figure 21 and Figure 22, stitching thread release assembly 574 includes locking or grappling form, wherein, the cam follower of anchor 576 576c can put in or cover operationally aligned distally depression to a depression corresponding in 434e, actuation member 577 release lever 577c can extend through the longitudinal slit 484 of anvil block 434, and the pin 577d of release lever 577c is disposed in and leads The first end of arcuate groove 575a of plate 575 or the first end of the arcuate groove 575a close to guide plate 575.It is contemplated that Stitching thread release assembly 574 includes frictional fit or snap-fitted function, for after manufacture/assembling process and apparatus Before 100 complete to launch securing member, maintain and/or keep stitching thread release assembly 574 to be in described locking or grappling shape all the time Under state.

As Figure 23 and 24, stitching thread release assembly 574 includes opening or discharging form, wherein, the cam follower of anchor 576 576c will not put in or cover operationally aligned distally depression to a depression corresponding in 434e, actuation member 577 release lever 577c does not extend through the longitudinal slit 484 of anvil block 434, and the pin 577d of release lever 577c is arranged The second end in the arcuate groove 575a of guide plate 575 or the second end of the arcuate groove 575a close to guide plate 575.

In apparatus 100 assembling process, stitching thread can be used to discharge assembly 574 by manufacturer, using surgical suture Line or tether, operation anvil block support member " B " is fixed in the tissue contacting surface of anvil block 434, then, by apparatus 100 End user when apparatus 100 completes to launch securing member, automatically by operation with anvil block support member " B " from the tissue of anvil block 434 Discharge in contact surface or release.

Reference picture 21-24, in the fabrication process, using opening or discharging form（Figure 23 and Figure 24）Under stitching thread release Put assembly 574, operation anvil block support member " B " can be covered in the tissue contacting surface of anvil block 434.Then, will perform the operation Inject distally depression with the first end of stitching thread " S1 " to one of 434e depression, and the by surgical suture " S1 " Two ends extend through operation anvil block support member " B1 "（With reference to Figure 15）And it is recessed to another in 434e to inject distally depression Cave.It is contemplated that the first end of surgical suture " S1 " includes node, stop or the like（Do not show）, its size Guarantee not passing through distally depression to the narrower depression in 434e.

Using being arranged in the second end to the surgical suture " S1 " in 434e for the distally depression, and be stowed through The operation surgical suture " S1 " of anvil block support member " B ", can be by instrument（Do not show）It is inserted through the arcuate groove of guide plate 575 575a is simultaneously engaged with the opening in the pin 577d of release lever 577c.With reference to Figure 21 and Figure 22, then, manipulation instrument passes through guide plate The 575 arcuate groove 575a or arcuate groove 575a along guide plate 575 moves, thus activating or move release lever 577c and rotating partially Cardiac prominence wheel 577a.With eccentric cam 577a rotation, boss 577b can rotate around the pivotal line of eccentric cam 577a and act on On two walls of elongated slot 576b of anchor 576, thus leading to anchor 576 around pivoting.With anchor 576 around Pivot, its cam follower 576c can be led to put in or cover distally depression to a depression in 434e, and be pressed on and be arranged in On the second end of surgical suture therein.Meanwhile, release lever 577c has been moved into can extend across the longitudinal direction of anvil block 434 The position of slit 484.As described above, now, stitching thread release assembly 574 is under locking or grappling form.Work as anchor 576 away from depression 434e when, ideally, with cam follower 576c cooperation distally depression 434e relatively wide so that allow seam Zygonema " S1 " can easily pierce into and pass depression 434e.It is arranged in another distally depression on anvil block 434 lateral sides 434e, can be of the same size, or can be small enough to enough to holding on stitching thread " S1 " and being fixed in suitably Position is with convenient for assembly.

In operation, using leaning against fixing operation on the lower surface of anvil block 434 with anvil block support member " B1 ", in apparatus During 100 transmitting securing members, it is advanced to farthest side position, blade 474 meeting with by actuated slider 440 from nearest side position Cut through the middle body of proximal suture " S2 ", thus operation is released from anvil block 434 with the near-end of anvil block support member " B1 " Get off.As shown in figure 24, in use, with apparatus 100 transmitting stroke close to terminate and with actuated slider 440 close to anvil The far-end of seat 434 longitudinal slits 484, the drive beam 462 being just transmitted screw rod 460 driving can contact release lever 577c, and promotion is released Put bar 577c, and next, so that eccentric cam 577a is rotated around its pivotal line.With eccentric cam 577a rotation, boss On two walls of elongated slot 576b that 577b can rotate around the pivotal line of eccentric cam 577a and act on anchor 576, from And lead to anchor 576 around pivoting.With anchor 576 around pivoting, its cam follower 576c can be led to move away from phase To a wider distally depression 434e, and discharge the second end of the surgical suture being arranged therein.Using being released Or the second end of free surgical suture, the far-end of operation anvil block support member " B1 " is free, so that and anvil block 434 tissue contacting surface separates.

With reference to Figure 15, nail bin groupware 432 defines the nearside depression being formed at its near-end to 432a, and described nearside is recessed Cave is arranged in 432a in the opposite sides of longitudinal slit 485, one depression in every side.Nail bin groupware 432 further defines shape The distally depression of Cheng Qi far-end is to 432b, and described distally depression is arranged in the opposite sides of longitudinal slit 485 to 432b On, one depression in every side.In one embodiment, nearside depression to 432a and distally depression in each pair depression in 432b at least One of depression be preferably non-circular and shrink, or be arranged to by be frictionally engaged and/or compress anchor log " S " its Its form.

Nail bin groupware 432 further includes operation nail bin supporting member " B2 ", pledget or other any suitable handss Art implant, it is operatively secured to upper surface or the contact tissue table of nail bin groupware 432 using anchor log " S3 " and " S4 " On face, thus covering the length of at least some securing member cave 442 and/or at least a portion longitudinal slit 485.Especially, grappling Part " S4 " is tightened up around portions of proximal and nearside depression in operation nail bin supporting member " B2 " each depression to 432a, and Anchor log " S3 " is also tightened up all to each depression of 432b in the distal part of operation nail bin supporting member " B2 " and distally depression Enclose.

In a specific embodiment, the first end of each anchor log " S " includes node, stop or the like（Not Display）, its size guarantees not passing through nearside depression to one of 432a depression, and the second end of each anchor log " S " Can cross, and laterally across, operation nail bin supporting member " B2 ", at least one times, then return again to through nearside depression to 432a Another depression.For example, the second end of each anchor log " S " can be compacted or tighten up another to 432a in nearside depression In one depression, so that grappling is lived the second end of anchor log " S " and operation nail bin supporting member " B2 " is nestled up nail bin group The tissue contacting surface of part 432 is fixed.Similarly, extend laterally across operation nail bin supporting member " B2 " using anchor log " S3 " And put in distally depression and engage in 432b.

When operation nail bin supporting member " B2 " is fixed on nail bin groupware 432, operation is included with nail bin supporting member " B2 " It is formed in its lateral edges the nearside recess pair 432a being alignd with the nearside depression of nail bin groupware 432, be formed in its lateral edges And the distally recess pair 432b being alignd with the distally depression of nail bin groupware 432, and be formed in its proximal and with longitudinal direction The nearside recess of slit 485 alignment.Operation nail bin supporting member " B2 " further includes the tongue extending out from its distal side edge Shape piece or key-shaped piece, operation nail bin supporting member " B2 " are attached on nail bin groupware 432 in assembling process with facilitating.Permissible It is contemplated that operation nail bin supporting member " B2 " can reduce in the width of its portions of proximal.It is further contemplated that arriving, will perform the operation After being fixed on nail bin groupware 432 with nail bin supporting member " B2 ", and before packaging or shipment, by described tongue-like pieces from handss Disassemble in art nail bin supporting member " B2 ".

As Figure 15 and Figure 25-29, nail bin groupware 432 further includes to be supported on the far-end of nail bin groupware 432 and far-end is attached Near nail bin release assembly 594.Release assembly 594 includes the locking that can pivotably be connected on nail bin groupware 432 Bar or anchor 595.Anchor 595 includes shank portion 595a with the cam follower 595b extending out from its edge.Cam follower 595b is operationally alignd to one of 432b depression with distally depression, preferably has larger width with distally depression centering That depression alignment of size.

Release assembly 594 further includes can pivotably be connected to anchor 595（As Figure 26 and Figure 27 institute Show）Anchor actuation member 597.Actuation member 597 includes positioning along the proximal of actuation member 597 and extending through First cam face 597a of the central longitudinal slit 485 of nail bin groupware 432, and from close to distally depression to 432b Second cam face 597b of the actuation member 597 of one depression distad horizontal expansion, distally depression is to this in 432b Depression is operably associated with the cam follower 595b of anchor 595.First cam face 597a of actuation member 597 is substantially Arc or convex.Actuation member 597 defines that hole or opening 597c, its structure and size can receive anchor therein 595 pin 595c, so that anchor 595 and actuation member 597 can rotate around pivoting or relative to each other.

In operation, actuation member 597 rotates around its pivoting point in the first direction, and its result is to lead to the second cam face The 597b and surface 432g of nail bin groupware 432（With reference to Figure 28 and Figure 29）Adjacent, thus mobile cam follower 595b at least partly crosses And/or pass through distally depression to that depression associated there in 432b.

As shown in figure 28, stitching thread release assembly 594 includes locking or grappling form, wherein, the first of actuation member 597 Cam face 597a puts in and passes through the central longitudinal slit 485 of nail bin groupware 432, wherein, the second CAM table of actuation member Face 597b is crushed on the surface 432g of nail bin groupware 432, thus the cam follower 595b of anchor 595 can put in or cover distally Depression is to operationally aligned that depression corresponding in 432b.Using by actuation member 597 is kept being in lock Mode under fixed or grappling form and the biasing member that engages with actuation member 597 or keeper, can allow securing member release group Part 594 is maintained under described locking or grappling form.When being under such locking or grappling form, can be by stitching thread " S3 " advances in the depression 432b of nail bin groupware 432.It is contemplated that stitching thread release assembly 594 includes frictional fit or takes Snap fit close function, for after manufacture/assembling process and apparatus 100 complete launch securing member before, maintain and/or keep Stitching thread release assembly 594 is under described locking or grappling form all the time.

As shown in Figure 27 and Figure 29, stitching thread release assembly 594 includes opening or discharging form, wherein, anchor 595 Cam follower 595b will not put in or cover distally depression to operationally aligned that depression corresponding in 432b, activate First cam face 597a of component 597 will not put in and pass through the central longitudinal slit 485 of nail bin groupware 432, and activates structure Second cam face 597b of part 597 will not be crushed on the surface 432g of nail bin groupware 432.

In the assembling process of apparatus 100, stitching thread can be used to discharge assembly 594 by manufacturer, using anchor log, handss Art stitching thread or tether " S ", by operation nail bin supporting member " B2 "（With reference to Fig. 2）It is fixed to nail bin groupware 432 contact tissue On surface, then, by apparatus 100 end user apparatus 100 complete launch securing member when, automatically operation nail bin is propped up Support member " B2 " discharges from the tissue contacting surface of nail bin groupware 432 or releases.

Reference picture 25-29, in the fabrication process, using opening or discharging the stitching thread release assembly 594 under form, can So that operation nail bin supporting member " B2 " to be covered in the tissue contacting surface of nail bin groupware 432.Then, by surgical suture The first end of " S " injects in a depression to relative narrowness in 432b for the distally depression, and the by surgical suture " S " Two ends extend through operation nail bin supporting member " B2 " and inject distally depression in a relatively wide depression in 432b. It is contemplated that the first end of surgical suture " S " includes node, stop or the like（Do not show）, its size guarantees It is not passed through distally depression to a narrower depression in 432b.

As shown in figure 26, nail bin groupware 432 includes being formed at access hole 583 therein, and described access hole is used for injecting simultaneously Receive stitching thread release assembly 594 therein, and can be close to actuation member 597.Using being arranged in distally depression to 432b In surgical suture " S " in a relatively wide depression the second end, and followed closely through operation using being stowed The surgical suture " S " of storehouse support member " B2 ", actuation member 597 can rotate around pivotal line, thus leading to actuation member 597 The first cam face 597a put in and pass through the central longitudinal slit 485 of nail bin groupware 432, and lead to actuation member 597 Second cam face 597b is pressed in the surface 432g of nail bin groupware 432（With reference to Figure 13 and Figure 14）On.By doing so it is possible, by means of The cam follower 595b of sufficient amount of anchor 595, anchor 595 can be around pivoting, thus putting in or to cover distally recessed Cave, to operationally aligned that depression corresponding in 432b, thus compresses the surgical suture being arranged therein The second end.As described above, now, stitching thread release assembly 594 is under locking or grappling form.

In operation, using the operation nail bin supporting member leaning against fixation in the tissue contacting surface of nail bin groupware 432 " B1 ", in the emission process of apparatus 100, advances with by actuated slider 440（I.e. from nearest side position to farthest side position）, Blade 474 can cut through the middle body of proximal suture " S4 ", thus by operation with the near-end of nail bin supporting member " B2 " from nail bin Release on assembly 432.As shown in figure 29, in use, with apparatus 100 transmitting stroke close to terminate and with actuating Slide block 440 is just being transmitted the far-end that screw rod 466 drives the central longitudinal slit 485 close to nail bin groupware 432, actuated slider 440 First cam face 597a of the contact activated component 597 of meeting, promotes actuation member 597 to rotate.Second cam of actuation member 597 Surface 597b also can rotate around the pivotal line of its pivot pin 595c.With the second eccentric cam surface 597b around the second cam face The pivotal line rotation of 597b, the distance between pivot pin 595c and surface 432g of nail bin groupware 432 can reduce, so that anchor Fixed pole 595 rotates around pivot pin 595c.With anchor 595 around pivoting, its cam follower 595b can be led to move away from relatively A wider distally depression 432b, and discharge the second end of the surgical suture " S " being arranged therein.Using being released Or the second end of free surgical suture " S ", the far-end of operation nail bin supporting member " B2 " is free, so as with nail The tissue contacting surface of storehouse assembly 432 separates.The distally depression 432b's operationally aliging with the cam follower 595b of anchor 595 Size makes, although anchor 595 rotates, stitching thread " S3 " will not still be tightened up wherein.

As by actuated slider 440, proximally position is advanced to distal position, blade 474 can longitudinally cut through or cutting operation With both anvil block support member " B1 " and operation nail bin supporting member " B2 ", thus support member " B1, B2 " is substantially divided into two halves. In addition, being advanced to farthest side position, the upright cam wedge 444 of actuated slider 440 with by actuated slider 440 from nearest side position Activating propeller 437, thus leading to propeller 437 vertically to translate in holding slit, and promoting securing member 433 away from slit 446.It is urged away from the slit 446 of nail bin groupware 432 with securing member 433, the nail leg of securing member 433 is pierced and passed through operation With anvil block support member " B1 " and operation nail bin supporting member " B2 ", and intervention any tissue therebetween, it is then possible to nestle up The anastomosis staple forming cavity of anvil block 434 or the anastomosis staple shaping intracavity forming in anvil block 434.Support member " B1, B2 " can include Segmentation support member simultaneously is convenient to remove the perforation of equipment from tissue.

According to the disclosure, operation anvil block support member " B1 " and/or operation nail bin supporting member " B2 " are difference preloadeds Arrive（I.e. from manufacturer there）On the anvil block 434 of end effector 400 or nail bin groupware 432.After load units transmitting, no The other end effector 400 do not launched or nail bin 432, either with or without support member " B ", can be loaded into apparatus 100 by pipe On.Support member and release assembly can be pre-loaded onto on dismountable nail bin it is possible to providing and will prop up for surgical apparatuses user Support member is loaded into the device on anvil assembly.It is, for example possible to use the support member with adhesive.As needed or require, fit Other support member for anvil block 434 and/or nail bin groupware 432 or replacement support member can be fixed to anvil block 434 or nail On storehouse assembly 432.

In another embodiment, can arrange to discharge assembly to cut off stitching thread " S ".Actuation member 597 can be arranged On cam face 597b with cam driven anchor 595 towards stitching thread " S ".Table towards the anchor 595 of stitching thread " S " Face can include sharp edge, and, when being activated by described transmission component, this surface can cut off described stitching thread.

As Figure 30-35, show another embodiment of end effector 400.The anvil block 434 of end effector 400 Including being disposed between anvil block 434 and anvil covers 435 and be in operationally with distally depression to 670e aligned position Stitching thread discharges another embodiment of assembly 674.Stitching thread release assembly 674 includes being pivotably connected to anvil block 434（Figure 32 and Figure 33）And/or the pitman arm 675 in optional anvil covers 435.Pitman arm 675 includes defining and is formed at it Cave in first side edge 675b or shank portion 675a of depression 675c, and be defined substantially along its adjacent side edge Or the cam face 675d of proximal.Cave 675c has generally arcuate, circular or round as a ball profile.As Figure 18 and Figure 20 institute Show, pitman arm 675 includes the pivot pin 675e extending out from shank portion 675a, for passing through pitman arm 675 around pivot It is rotationally connected on anvil block 434.

Release assembly 674 further includes can pivotably be connected on pitman arm 675 and be slidably disposed Push rod 677 between anvil block 434 and anvil covers 435.Push rod 677 includes the shank portion with substantially rectangular cross-sectional configuration structure 677a, and extend out from the angle of shank portion 677a and there is head 677b of substantially circular or round as a ball structure. The structure of head 677b of push rod 677 and size around pivoting and/or can be rotatably connected in the cave 675c of pitman arm 675 In.

As shown in figure 34, stitching thread release assembly 674 includes not activating form, and wherein, push rod 677 will not put in or cover On operationally aligned distally depression in the corresponding depression in 670e, and, the longitudinal axiss of pitman arm 675 The longitudinal axis being oriented substantially parallel to end effector 400 of line.It is contemplated that stitching thread release assembly 674 includes Frictional fit or snap-fitted function, for after manufacture/assembling process and surgical stapling equipment complete transmitting before, dimension Hold and/or keep stitching thread release assembly 674 to be in all the time under locking or grappling form.

As shown in figure 35, stitching thread release assembly 674 includes activating form, and wherein, push rod 677 puts in or covers and can grasp Make aligned distally depression to a depression corresponding in 670e, and, the orientation base of the longitudinal axis of pitman arm 675 Transverse to the longitudinal axis of end effector 400 in basis.

Reference picture 30-35, in the fabrication process, using not activating the release assembly 674 of the stitching thread under form, can be by Anvil block support member is used in operation（Do not show）Cover in the tissue contacting surface of anvil block 434.Then, by surgical suture " S1 " First end inject distally depression to one of 670e depression, the second end of surgical suture " S1 " is extended through Anvil block support member is used in described operation（Do not show）And inject distally depression to another depression in 670e.It is contemplated that it is remote Side depression is the slit that the beginning shrinks to each depression in 670e, is arranged in it will pass through friction and hold to or hold on In surgical suture " S1 ".

In operation, using the operation anvil block support member leaning against fixation on the lower surface of anvil block 434（Do not show）, in handss In the emission process of art anastomosis apparatus, just it is being transmitted the drive beam 462 of screw rod 460 driving with propulsion（I.e. from nearest side position Move to farthest side position）, blade 474 can cut through described proximal suture（Do not show）Middle body, thus by described handss Art anvil block support member（Do not show）Near-end release from anvil block 434.As shown in figure 35, in use, with described The transmitting stroke of surgical stapling equipment is close to end and farthest close to the longitudinal slit 484 of anvil block 434 with described drive beam End, drive beam 462 can contact the cam face 675d of pitman arm 675, thus promoting pitman arm 675 to rotate or around pivot pin rotation Turn, and, next promote push rod 677 along the direction translation of described slit.Translate with push rod 677, push rod 677 touches The second end of stitching thread " S1 " is simultaneously pushed out operationally aligned distally depression 670e, with from wherein discharging suture The second end of line " S1 ".Using be released on distally depression 670e or free surgical suture " S1 " the second end Portion, the far-end of operation anvil block support member " B1 " is free, to separate with the tissue contacting surface of anvil block 434.

As shown in Figure 30,31 and 36-50, the nail bin groupware 432 of end effector 400 includes being supported in its far-end and remote Nail bin release assembly 694 near end.Release assembly 694 includes keeper 695, and it is supported on the far-end of nail bin groupware 432, And the proximate distal ends being located at longitudinal slit 485 and the part extending at least across longitudinal slit 485.Keeper 695 includes Main part 695a, the boss 695b extending out from its surface, and define formation in its surface and extend through its side The passage in face or depression 695c.When being supported in nail bin groupware 432, the depression 695c meeting of keeper 695 and nail bin groupware 432 distally depression aligns to one of 682f depression.

Release assembly 694 further includes the biasing member 696 having headed portion 696a, and head divides 696a can revolve around pivot It is connected on the boss 695b of keeper 695 with turning.Biasing member 696 further includes that from the beginning part 696a extends out One leg member 696b and be connected to via moveable hinge joint 696d the first leg member 696b free end the second supporting leg structure Part 696c.Biasing member 696 further includes to be connected to the free end of the second leg member 696c via moveable hinge joint 696f Piston 696e.Piston 696e is slidably disposed in the depression 695c of keeper 695, and piston 696e can be in depression Translate in 695c.In some other embodiments, described propeller is the link assembly with first connecting rod, described first connecting rod One end can pivotably be connected on described nail bin.The other end of described first connecting rod can pivotably be connected to The first end of second connecting rod.The opposite end of described second connecting rod, i.e. the second end, it is limited in the depression of described keeper.

As shown in figure 39, release assembly 694 includes not activating form, and wherein, piston 696e will not put in or cover remote Side depression is to that depression corresponding in 682f, and the first leg member 696b and the second leg member 696c is with respect to that This is angled, and longitudinal slit 485 proximad along nail bin groupware 432 stretches out.It is contemplated that stitching thread release group Part 694 includes frictional fit or snap-fitted function, for after manufacture and/or assembling process and surgical stapling equipment is complete Before becoming transmitting, maintain and/or keep stitching thread release assembly 694 to be in all the time under locking or grappling form.

As shown in figure 40, stitching thread release assembly 694 also includes activating form, and wherein, piston 696e can put in or cover On operationally aligned distally depression to that depression corresponding in 682f, and the first leg member 696b and Two leg member 696c can extend substantially along common axis.

As Figure 36-40, in the fabrication process, using not activating the release assembly 694 of the stitching thread under form, operation is used Nail bin supporting member（Do not show）Cover in the tissue contacting surface of nail bin groupware 432.Then, by surgical suture " S3 " First end injects distally depression in one of 682f depression, and the second end of surgical suture " S3 " is extended through Cross described operation nail bin supporting member and inject distally depression in another depression in 682f.It is contemplated that at least with The adjacent depression 682f of keeper 695 is the slit that the beginning shrinks, and is arranged therein with will pass through friction and holding to or hold on Surgical suture " S3 ".

In operation, using the operation nail bin supporting member leaning against fixation in the tissue contacting surface of nail bin groupware 432（Not Display）, in the emission process of surgical stapling apparatus 100, just it is being transmitted the actuated slider 440 of screw rod 466 driving with propulsion （Move to farthest side position from nearest side position）, blade 474 can cut through proximal suture（Do not show）Middle body, from And the near-end of operation nail bin supporting member is released from nail bin groupware 432.As shown in figure 29, in use, with setting about The transmitting stroke of art coinciding machine 100 is close to be terminated and is just being transmitted screw rod 466 with actuated slider 440 to drive close to nail bin group The far-end of the central longitudinal slit 485 of part 432, can drive actuated slider 440 to contact the first leg member 696b and the second supporting leg Moveable hinge joint 696d between component 696c.With distally advancing actuated slider 440 further, can be by actuated slider 440 To moveable hinge joint 696d extruding, thus leading to the first leg member 696b and the second leg member 696c to extend.With first Leg member 696b and the second leg member 696c extends, and piston 696e can translate across the depression 695c of keeper 695.With Piston 696e translates across the depression 695c of keeper 695, and piston 696e can be engaged with the second end of stitching thread " S3 ", and will The distally depression 682f that stitching thread " S3 " release can be alignd therewith, with from the second end wherein discharging stitching thread " S3 ".Using Distally be released on depression 682f or free surgical suture " S3 " the second end, operation nail bin supporting member " B " Far-end be free to separate with the tissue contacting surface of nail bin groupware 432.

Other embodiments according to the disclosure it is contemplated that, support member " B " can be provided with or be formed with from it The wing of the one extending out or key-shaped piece, for inject and/or receive anvil assembly and/or nail bin groupware distally and/or Nearside depression.It is further contemplated that arriving, stitching thread " S " can be fixed to, embed or be otherwise connected to support member " B " On.

Example for disclosed herein surgical stapling apparatus be used together has been shown and described in following document Property operation use support member " B ", the full content of wherein each patent is incorporated herein by reference：Commonly assigned U.S. Patent No. 5,542, No. 594, the 5th, 908, No. 427, the 5th, 964, No. 774 and the 6th, 045, No. 560, it is filed on October 15th, 2009 Serial No. 12/579,605 commonly assigned U.S. Patent application（Disclose the 2010/0092710th for United States Patent (USP) now Number）, it is filed in the commonly assigned U.S. Patent application of in September, 2005 Serial No. of 30 days 11/241,267（It is U.S. now State's patent discloses No. 2006/0085034）, and the U.S. being filed in the Serial No. 11/248,846 on October 12nd, 2005 State's patent application（United States Patent (USP) discloses No. 2006/0135992, is U.S. Patent No. 7,823,592 now）.

Operation can be made up of suitable compatible and biological absorbable the material of biology with support member " B ".Operation is used Support member " B " can be made up of the non-absorbent material that cannot retain liquid.Operation support member " B " can lean on and is polymerized by saccharic acid Thing（GLYCOMER631）（Block copolymer）" BIOSYN " that make is manufactured into, described glycomer be a kind of by Acetic acid, hydroxy-, bimol. cyclic ester, PDO and the synthesizing polyester of trimethylene carbonate composition.

One block of the copolymer of gained is included derived from para-dioxane ketone（1,4- dioxanes -2- ketone）And trimethylene Carbonic ester（1,3- dioxanes -2- ketone）Random incorporation unit.Second block of described copolymer includes handing over derived from second The unit of the random incorporation of ester and para-dioxane ketone.The polyester of gained is to have about 60% Acetic acid, hydroxy-, bimol. cyclic ester, about 14% PDO, The ABA three block terpolymer of about 26% trimethylene carbonate.

It will be appreciated that various modifications can be carried out to described embodiment disclosed herein.For example, apparatus 100 does not need Using anastomosis staple, but two parts securing member that can be both known about using this area.Furthermore, it is possible to modification anastomosis staple or securing member The length of linear row is meeting the requirement of particular procedure.Then, the length of the single stroke of described actuator shaft and/or can abandon In formula load units, the length of the linear row of anastomosis staple and/or securing member can correspondingly change.Therefore, description above is not Should be considered as limiting, be only the signal of some specific embodiments.Those skilled in the art's claim appended here Other modifications will be envisioned in the scope and spirit of book.

Claims (16)

1. a kind of surgery systems, it includes：

Handle casing；

Clamp assemblies, it includes：

Dismountable nail bin groupware, it includes multiple securing members and longitudinal slit；

Anvil block, has securing member profiled surface thereon, and described nail bin groupware and anvil block are mounted in open position and close fit Alignment moves relative to each other between the make position of grip tissue；

Actuated slider, it is supported in described nail bin groupware, and described actuated slider is can move multiple tight for promoting Firmware is away from described nail bin groupware；

Drive beam, it includes vertical support and the cam member being supported on described vertical support, and described cam member disposes Become with respect to the translation of described anvil block, for described anvil block being maintained at closed position during transmitting securing member, and institute State vertical support to be positioned to adjoin with described actuated slider；And

Drive screw, which defines first longitudinal direction axis and is supported in described dismountable nail bin groupware, described transmission Screw rod has threaded portion, and wherein, described drive beam can be threadedly coupled on the described threaded portion of described drive screw, makes The rotation obtaining described drive screw can drive described drive beam lengthwise movement；And

Elongate body, it is configured to couple together described handle casing and clamp assemblies, and described elongate body includes limiting Second longitudinal direction axis and described drive screw is mechanically coupled to the flexible drive shaft on the actuator shaft of described handle casing, Wherein, the rotary motion of actuator shaft can be delivered on described drive screw for described power transmission shaft, and described elongate body includes flexibility Part, and wherein, described flexible drive shaft is contained in described flexible portion；And

Kinematic link, described flexible drive shaft and drive screw are coupled together by it, and wherein said kinematic link is with respect to described First longitudinal direction axis and second longitudinal direction axis runout arrangement.

2. surgery systems according to claim 1, wherein, described flexible portion includes multiple interlocked segments.

3. surgery systems according to claim 1, wherein, described kinematic link includes joining with described flexible driving shaft mechanical The nearside bonding part connecing and the distally bonding part with described drive screw mechanical attachment.

4. surgery systems according to claim 3, wherein, described nearside bonding part includes pod, its structure and size Can mechanically engage with the ball-and-socket joint being arranged in described flexible drive shaft far-end.

5. surgery systems according to claim 3, wherein, described distally bonding part includes pin, its structure and size Can mechanically engage with the U-clamp being arranged in described drive screw proximal end.

6. surgery systems according to claim 1, further include：

Operation support member, it is releasably fixed at least one of tissue in described anvil block and described nail bin groupware and connects On tactile surface, wherein, described operation support member is fixed in described anvil block and nail bin groupware extremely by least one anchor log On few one of, and wherein, in described anvil block and nail bin groupware, at least one of which defines for described in receiving at least one The lateral slit of the end of individual anchor log；And

Release assembly, it is disposed at least one of which in described anvil block and nail bin groupware.

7. surgery systems according to claim 6, wherein, described drive screw is configured to activate described release assembly, Thus discharging removing operation support member in described anchor log and at least one of which from described anvil block and nail bin groupware.

8. a kind of surgery systems, it includes：

Clamp assemblies, it includes:

Nail bin groupware, it includes multiple securing members and longitudinal slit；

Anvil block, has securing member profiled surface thereon, and described nail bin groupware and anvil block are mounted in open position and close fit Alignment moves relative to each other between the make position of grip tissue；

Actuated slider, it is supported in described nail bin groupware, and described actuated slider is can move multiple tight for promoting Firmware is away from described nail bin groupware；

Drive beam, it includes cam member, and described cam member is positioned to translate with respect to described anvil block, in transmitting fastening During part, described anvil block is maintained at closed position；And

Drive screw, which defines first longitudinal direction axis and is supported in described nail bin groupware, described drive screw has spiral shell Stricture of vagina part, wherein, described drive beam can be threadedly coupled on the described threaded portion of described drive screw so that described transmission The rotation of screw rod can drive described drive beam lengthwise movement；

Elongate body, it is configured to be connected with described clamp assemblies, and described elongate body includes defining second longitudinal direction axis Flexible drive shaft, described power transmission shaft can transmit rotary movement on described drive screw；And

Kinematic link, described flexible drive shaft and drive screw are coupled together by it, and wherein, described kinematic link is with respect to described First longitudinal direction axis and second longitudinal direction axis runout arrangement, described clamp assemblies and elongate body are each other can be detached, institute State elongate body to be configured to be connected with actuator.

9. surgery systems according to claim 8, further include power supply, and described power supply is configured to provide electric energy.

10. surgery systems according to claim 9, further include control assembly, and described control assembly is configured to Accept at least one user input.

11. surgery systems according to claim 10, further include the first motor, and described first motor is coupled to institute State on power supply and be configured to respond at least one user input described and run.

12. surgery systems according to claim 11, further include the second motor, and described second motor is coupled to institute State on power supply and be configured to respond at least one user input described and run.

13. surgery systems according to claim 12, further include to select transmission case assembly, described selection change speed gear box group Part includes at least one teeth parts with described flexible drive shaft mechanical attachment, and wherein, described first motor is configured to select Property ground at least one teeth parts mobile described be meshed with described second motor, thus activating described flexible drive shaft.

14. surgery systems according to claim 8, wherein, described drive beam is included for supporting described cam member simultaneously Promote the vertical support of described slide block.

15. surgery systems according to claim 8, further include shell, and described inside the shell has motor.

16. surgery systems according to claim 8, further include control assembly, and described control assembly is configured to Accept user input.